Active NPI
Jacob Michelsen, PA
- Medical Physician Assistant
- Caldwell, ID
National Provider Identifier
1841803533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 2005 Arlington Ave
Caldwell, ID 83605-4808 - Phone
- (208) 459-1025
- Fax
- (208) 466-5359
- NPI assigned
- Aug 24, 2020
- Last updated
- Aug 24, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | NU | Primary |
Addresses
Primary practice location
2005 Arlington Ave
Caldwell, ID 83605-4808
Mailing address
PO Box 9
Nampa, ID 83653-0009
Phone (208) 461-7149
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2020 S Johns Ave
Suite B
Emmett, ID 83617-9410
Phone (208) 369-4340
2310 Gem Ave
Emmett, ID 83617-9625
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Interoperability endpoints
- jacob.michelsen.1@23758.direct.athenahealth.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598227200000",
"number": "1841803533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9",
"city": "NAMPA",
"state": "ID",
"postal_code": "836530009",
"telephone_number": "208-461-7149",
"fax_number": "208-467-3391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2005 ARLINGTON AVE",
"city": "CALDWELL",
"state": "ID",
"postal_code": "836054808",
"telephone_number": "208-459-1025",
"fax_number": "208-466-5359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICHELSEN",
"first_name": "JACOB",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-24",
"last_updated": "2020-08-24",
"certification_date": "2020-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Caldwell, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.